Gaming the Liver Transplant System
Abstract: This paper examines the impact of a reform designed to curtail the strategic manipulation of the liver transplant waiting list. Prior to March 1, 2002, livers were allocated by a standards based regime in which strategic misrepresentation of severity of patient illness could enhance a center’s chances of performing a transplant. After March 1, 2002, a rules-based allocation regime was introduced that eliminated subjective factors in the allocation of livers. Using this policy change to identify strategic manipulation of the waiting list, I show an association between highly competitive transplant markets and an increased willingness to misrepresent patient need to obtain livers.
